One day I was listening to a hospitalist express concerns about the nursing staff, a team of professionals I had the pleasure of leading. She voiced her concerns in the form of a question, “Why do the nurses care as much about the patient’s diet and toileting habits as they do about the potassium drip and the choice of antibiotic?” After thinking about this for a while I responded, “The nurses care, because it’s what matters to the patients.” It was then that I realized those two simple words, what matters, can have a profound impact on the relationships we build with patients.
How many of us approach a patient encounter already anticipating what the patient is going to say? Are you guilty of having rehearsed a response in your head before meeting the patient? Perhaps you have a standard response you’ve used a thousand times with other patients just like this one? Don’t forget that you have to see another patient in about 10 minutes!
All of us face similar challenges in communicating with patients. While many of us are not experts in patient communication, by practicing the following communication techniques, along with perhaps a little different mindset, we can be more effective.
Use open-ended questions
What's on your mind? What brings you in today? These are open-ended questions that will quickly establish the primary concerns the patient wants to discuss. This will also give us some indication of how much the patient knows about their medical situation. If patients have the opportunity to express themselves in a non-judgmental and accepting atmosphere, they may disclose more information than if they had been asked a simple ‘yes’ or ‘no’ question. Framing the conversation in this manner will give insight into the patient’s perspective, including their expectations and even their cultural beliefs. You might be thinking that giving the patient the floor could take way too much time. However, allowing a patient to speak freely has been found to take only 6 seconds longer than if the clinician leads the conversation.
Listen to the patient with the intent to understand rather than to respond. Physicians have been found to interrupt a patient within an average of 16 seconds of asking an open-ended question. How can we possibly learn what matters to the patient in 16 seconds? Patients want us to listen to them. They want to be heard and understood, and we can’t do that unless we listen. In fact, the Beryl Institute found that among patients of all generations, listening to them was considered the most important element of the patient’s experience.
Try reverse teach-back
We’ve probably all heard about the teach-back method. This is an evaluation technique where we prompt the patient to repeat back to us, in his or her own words, what they understood about our conversation. Reverse teach-back is an excellent strategy that we can use to evaluate our understanding of what the patient stated to us. In other words, we “teach back” to the patient what it is we heard them say. Summarize the key points and clarify if your understanding was correct. It is only then that you should begin to work on a conclusion to the conversation or solution to the problem(s).
Becoming an efficient and effective patient communicator takes time and practice. The process starts with self-reflection and an awareness of how we can best hear what the patient has to say. Start by asking the patient open-ended questions to get to the heart of the problem. This will give you the clinical clues you’re seeking, insights into the patient’s expectations and help you build a rapport. Listen to your patient without interrupting. Finally, summarize what you heard the patient say through reverse teach-back and work together on a plan of care that works for you both.
The patient’s time is just as valuable as ours. Maximize your time together by working on your patient communication skills. Take time to consider the what matters and you may find that future conversations are more meaningful for you both.
About the author. Laura Hoffman is a programmatic advisor for the Transforming Clinical Practice Initiative with the Vizient performance management team. She is a registered nurse who has held several different nursing leadership positions throughout her career. She is passionate about patient and family engagement and patient-centered care. Hoffman holds a master of science in nursing and will graduate in November 2019 with a doctor of nursing practice from Walden University.